Hodgkin Lymphoma: The Basics
Hodgkin lymphoma is a cancer of the lymphatic system—the network of vessels and nodes that moves fluid through your body and fights infection. What makes it different from other lymphomas is the presence of a specific abnormal cell called a Reed-Sternberg cell. When a pathologist looks at a tissue sample under a microscope and finds these cells, the diagnosis is Hodgkin lymphoma. Without them, it is a different type of lymphoma called non-Hodgkin lymphoma.
The disease starts when lymphocytes—a type of white blood cell—become cancerous and multiply out of control. In Hodgkin lymphoma, these cancer cells usually gather in lymph nodes in the chest, neck, or armpits, though they can spread to other parts of the body. The cancer grows more slowly than some other blood cancers, and it tends to spread in an orderly way from one lymph node group to nearby groups, rather than jumping randomly throughout the body.
Hodgkin lymphoma can occur at any age, but it is most common in people in their 20s and in people over 55. It accounts for roughly 10 percent of all lymphomas diagnosed in the United States. The exact cause is not fully understood, though certain factors—including infection with Epstein-Barr virus, a weakened immune system, or a family history of lymphoma—may increase risk.
Key Takeaways
- Hodgkin lymphoma is diagnosed by finding Reed-Sternberg cells in a tissue sample, which distinguishes it from non-Hodgkin lymphoma.
- The cancer starts in lymphocytes and typically spreads in an orderly pattern from one lymph node group to nearby groups.
- Symptoms often include enlarged lymph nodes, fever, night sweats, and fatigue, though some people have no symptoms and discover it during imaging for another reason.
- Staging—determining how far the cancer has spread—is the first step after diagnosis and guides treatment decisions.
- Treatment options include chemotherapy, radiation, stem cell transplant, and newer targeted drugs, and the choice depends on stage, age, and other health factors.
How Hodgkin Lymphoma Develops and Spreads
Hodgkin lymphoma begins when a single lymphocyte develops a genetic mutation that causes it to divide repeatedly. These abnormal cells accumulate in lymph nodes, causing them to enlarge. The cancer typically spreads in a predictable pattern—from one node group to the next closest group—rather than appearing randomly in distant sites. This orderly spread is one reason staging (mapping where the cancer is) matters so much for treatment planning.
The disease can involve lymph nodes in the neck, chest, armpits, abdomen, or groin. It can also spread to organs like the lungs, liver, or bone marrow, though this is less common at diagnosis. The stage of the disease—how far it has spread—is one of the most important factors in deciding what treatment will work best.
Symptoms and How Diagnosis Happens
Many people with Hodgkin lymphoma notice enlarged lymph nodes—usually in the neck, chest, or armpits—that do not go away after a few weeks. Some experience B symptoms: fever, night sweats that soak through clothing, and unexplained weight loss. Others feel tired, have itching skin, or notice pain in lymph nodes after drinking alcohol. Some people have no symptoms at all and discover the disease when imaging done for another reason shows enlarged nodes.
Diagnosis requires a tissue sample. A doctor will perform a biopsy—removing a small piece of an enlarged lymph node—and send it to a pathologist. The pathologist looks for Reed-Sternberg cells under a microscope. If they are present, the diagnosis is Hodgkin lymphoma. The pathologist also identifies which subtype it is, because there are several types of Hodgkin lymphoma, and each behaves slightly differently.
Once Hodgkin lymphoma is diagnosed, you will have additional tests to determine the stage. These include CT scans of the chest, abdomen, and pelvis; PET scans; and sometimes bone marrow biopsy. Staging tells your doctor how far the cancer has spread and is essential for planning treatment.
Stages and What They Mean
Hodgkin lymphoma is staged using the Lugano classification, which ranges from Stage I to Stage IV. Stage I means cancer is in one lymph node group. Stage II means it is in two or more node groups on the same side of the diaphragm (the muscle that separates the chest from the abdomen). Stage III means it is on both sides of the diaphragm. Stage IV means it has spread to organs outside the lymph nodes, such as the liver, lungs, or bone marrow.
Each stage is further divided based on whether you have B symptoms (fever, night sweats, weight loss). A stage with a B means you have these symptoms; without a B means you do not. For example, Stage IIA means cancer in two node groups on one side of the diaphragm with no B symptoms, while Stage IIB means the same spread but with B symptoms present. This distinction affects treatment intensity.
Stage alone does not determine your prognosis. Age, overall health, and how well your body responds to initial treatment also matter. Your doctor will discuss what your specific stage means for your treatment options and outlook.
Treatment Options for Hodgkin Lymphoma
Treatment depends on the stage, your age, and your overall health. For early-stage disease (Stage I or II), chemotherapy alone or chemotherapy combined with radiation therapy is common. For advanced-stage disease (Stage III or IV), chemotherapy is usually the main treatment, sometimes followed by radiation to areas where there was a large mass of cancer.
The most widely used chemotherapy regimen is called ABVD, which combines four drugs given in cycles over several months. Other regimens exist and may be used depending on your situation. Radiation therapy focuses high-energy beams on affected lymph nodes to kill cancer cells. Stem cell transplant—where your own blood-forming cells are collected, stored, and then returned to your body after high-dose chemotherapy—may be used if the cancer returns or does not respond to initial treatment.
Newer treatments include targeted drugs and immunotherapies that work differently than traditional chemotherapy. Brentuximab vedotin targets a protein on Hodgkin lymphoma cells. Checkpoint inhibitors like nivolumab and pembrolizumab help your immune system recognize and attack cancer cells. Your oncologist will discuss which treatments are appropriate for your stage and circumstances.
Survival Rates and Long-Term Outlook
Hodgkin lymphoma has one of the better survival rates among cancers. Overall, roughly 90 percent of people diagnosed are alive five years after diagnosis. Survival varies by stage: people with early-stage disease have higher five-year survival rates than those with advanced-stage disease. Age also matters—younger people tend to have better outcomes than older people, though treatment has improved for all age groups.
Many people treated for Hodgkin lymphoma go into remission and never have the disease return. Others may have a recurrence months or years later. If recurrence happens, additional treatment options are available, including different chemotherapy regimens, targeted drugs, or stem cell transplant.
Long-term survivors should be aware that some cancer treatments can have late effects—health problems that appear years after treatment ends. These may include heart or lung problems, secondary cancers, or fertility issues. Your oncologist will recommend follow-up care and screening to monitor for these possibilities.
Living With Hodgkin Lymphoma During and After Treatment
During chemotherapy or radiation, you may experience side effects like nausea, fatigue, hair loss, or increased infection risk. Your medical team can offer medications and strategies to manage these. Many people continue working or attending school during treatment, though the intensity of your schedule may need to change. Talking with your employer or school about your diagnosis and treatment timeline can help you plan.
After treatment ends, follow-up appointments with your oncologist are important. These visits typically include physical exams and imaging to watch for recurrence. The frequency of visits decreases over time if you remain in remission. Support groups—whether in person or online—connect you with others who have had Hodgkin lymphoma and can be valuable for managing the emotional side of diagnosis and recovery.
Frequently Asked Questions
Is Hodgkin lymphoma hereditary?
Hodgkin lymphoma is not inherited in the way that some genetic conditions are. However, having a family member with lymphoma may slightly increase your risk. Most people diagnosed have no family history of the disease.
Can Hodgkin lymphoma be cured?
Many people with Hodgkin lymphoma are cured with treatment, especially those diagnosed at early stages. Even those with advanced-stage disease have good chances of remission. Cure rates have improved significantly over the past few decades as treatments have advanced.
What is the difference between Hodgkin and non-Hodgkin lymphoma?
The main difference is the presence of Reed-Sternberg cells, which are found in Hodgkin lymphoma but not in non-Hodgkin lymphoma. Non-Hodgkin lymphoma is actually a group of many different types of lymphoma. Hodgkin lymphoma tends to spread more predictably and often has a better outlook than many types of non-Hodgkin lymphoma.
Will I lose my hair during treatment?
Hair loss depends on the type of treatment. Some chemotherapy drugs cause hair loss; others do not. Radiation therapy only affects hair in the area being treated. Your oncologist can tell you what to expect based on your specific treatment plan.
Can I work during chemotherapy?
Many people continue working during treatment, though the intensity and schedule may need adjustment. This depends on the type of work, the treatment regimen, and how you respond to it. Discussing your situation with your employer and medical team can help you plan what is realistic for you.